The purpose of this expert meeting is to assess the current evidence base for informing quality-based purchasing in developing countries, and to develop a research agenda that will guide future research investments on this important topic. Increasingly, stakeholders in the global health care debate are recognizing the potential power of purchasers National and regional governments, community mutual organization organizations, employers, employers, consumers in influencing quality goals. In the United States, the Agency for Health Quality and Research (AHRQ) has long recognized the potential power of public and private employers and coalitions to advance quality considerations in health care purchasing arrangements in its value-based purchasing initiatives. The World Health Organization (WHO) further acknowledged the "the role of contractual arrangements in improving health systems performance in countries across the globe through a 2002 referendum that included a recommendation that evidence on the impact of health services purchasing arrangements be gathered to enable an evaluation of the impact of these models and to identify best practices. To date, however, there has been no systematic assessment of what we know about the effectiveness of specific purchasing strategies and the overall feasibility of purchasers as a force for quality in developing countries. Moreover, there has been no systematic assessment of what we need to know to contribute to the global quality discussion and further the global quality agenda. This expert meeting, and the resulting research agenda, will fill an important gap and contribute to the global debate on assuring quality of care.